If you need a more accessible version of this website, click this button on the right. Switch to Accessible Site


You are using an outdated browser. Please upgrade your browser to improve your experience.

Close [x]

Follow Us

At Plaza Vision Center, we value your time. In an effort to save you time in our office, you can download and complete our patient form(s) prior to your appointment.

  • You will need AdobeReader® to download and complete the forms. Click here to download.
  • Download the required form(s). Print out the form(s) and complete the required information.
  • Fax your printed and completed form(s) to our office or bring them with you to your appointment.

Patient Forms

Please complete this form as it lets us know the history and current state of your health. Let us know what questions, concerns, and goals your have regarding your eye health or vision on the form.

2010-04 PVC On-Line Form File.pdf

A2010-04 PVC On-Line Introduction Sheet.pdf

B2010-03 PVC On-Line New Patient Demographic Information.pdf

C2010-04 PVC On-Line Insurance Verification Form.pdf

D2010-03 PVC On-Line History and ROS Form.pdf

E2010-04 PVC On-Line Notice of Privacy Practices.pdf

F2010-03 PVC On-Line Ackowledgement of Pirvacy Practices.pdf

Download the Free AdobeReader®